Archived: Seaforth Lodge

Updated 24 October 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 19 July 2017 and was unannounced. The inspection team consisted of two inspectors and one expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We reviewed information we held about the service from previous inspections, notifications they had sent in to us alerting us of important events in the service and any feedback from key stakeholders received over the last six months. We also spoke with the local authority who had been working with the service to improve the quality of care.

During the inspection visit, we spoke with nine people using the service, and four of their relatives. We talked with four care staff and the chef and interviewed the registered manager. We looked at care plans and risk assessments for six people, and their daily care records. We looked at health and safety information, policies and procedures, staff files and complaints and safeguarding information.

We observed care in communal areas throughout the day and completed a Short Observational Framework Intervention (SOFI) during lunch and dinner. SOFI is a way of observing care interactions for people who may not be able to communicate with us because of their individual support needs. We also spoke with three health and social care professionals during the inspection process.

Updated 24 October 2017

At our last inspection of this service on 7 February 2017 we found breaches of nine legal requirements. We rated the service as Inadequate and it was placed into Special Measures. We served five enforcement warning notices on both the registered provider and registered manager. These were in respect of safe care and treatment, meeting nutritional and hydration needs, safeguarding, staffing, and good governance. This report details the findings of a comprehensive inspection and also covers whether the warning notices have been complied with.

At this inspection we found improvements had been made in some areas of concern, the issues raised in the warning notices had been partly addressed. However, the service was still in breach of five legal requirements.

This inspection took place on 19 July 2017 and was unannounced. Seaforth Lodge is registered to provide accommodation with personal care for up to 21 people; at the time of this inspection there were 14 people living there. Seaforth Lodge is a converted house in a residential area of North London; it has a garden and is close to local amenities.

As a condition of its registration the provider is required to have a registered manager in place. There was a registered manager in post at the time of our inspection. There was also another registered manager who was not working as a registered manager but had yet to de-register despite our advice to do so. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Supervision was taking place regularly and training courses had been booked to boost staff knowledge on meeting people’s needs. Staffing levels had increased and there were extra staff in the morning at the busiest point in the day. People were having their needs better met because of the increase in staff; this meant there was no longer a breach in legal requirements in the area of staffing.

Improvements in the consistency of recording consent meant the service was now meeting legal requirements in the area of consent and in following the principles of the Mental Capacity Act 2005.

We found that efforts had been made to capture more person-centred information in care files and involve relatives more. Where people were not having their preferences met for showering and bathing at our previous inspection, some improvements had been made in this area. This meant that although there was still some improvement to be made, the service was no longer in breach of legal requirements around person-centred care.

However, safe care and treatment was not being provided and a continuing breach of legal requirements was found in this area. Many times throughout the day people were put at risk of being given food that was not suitable for them, which placed them at risk of worsening health. People were also put at risk of pressure ulcers developing through not being repositioned regularly, and at risk of falling when mobility equipment was not used.

We also found a continuing breach of legal requirement in the area of premises and equipment. New wheelchairs and shower equipment had been ordered and equipment was cleaner. Despite this, the premises was not secure, with one ground floor window wide open throughout the day. This window and another on the first floor did not have a fully functional window restrictor fitted. This placed people at risk of an intruder climbing in through the window and someone falling or climbing out of the first floor window.

At our last inspection we found a breach in legal requirements around nutrition and hydration. At this inspection we saw professional advice had been followed in regards to fortification of food with cream and milk and butter where needed.

Staff told us they felt more supported since the last inspection. During the inspection there was insufficient oversight of the care being provided resulting in errors that affected people and put them at risk. There were no audits of people’s daily care records and gaps not being identified. This resulted in a negative impact on people’s safety. There was no quality assurance support from the provider for the registered manager. We found a repeated breach of legal requirements in the area of governance.

There were overall four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 arising at this inspection. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service therefore remains in 'Special Measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.